recovery

I’m happy you’re still reading my daily series on how to get through December without bingeing. What a week! So happy it’s Thursday already.

We are getting knee deep into holiday parties so remember to keep coming here for tips and inspiration.

Todays Tip

Did you know that often, in the Winter, people binge eat because they are cold? FACT.

Eating raises your metabolism and warms you up. So other things to do when you have the urge to binge because you’re cold? Drink a cup of tea, take a hot bath or shower, do 30 jumping jacks, cuddle under a blanket, stretch your body, turn the heat up, put on extra sweaters… This is a physical reason for bingeing and one leftover from evolution. We no longer need to bulk up for Winter because we have coats and heat and houses to keep us warm. We don’t have to cuddle up under animal pelts in caves. Don’t blame yourself! It’s biology’s fault.

Inspirational Quote

“You must do the things you think you cannot do.” – Eleanor Roosevelt

This is an important one– because we are only limited by our own beliefs. When you challenge those beliefs, the world becomes completely open to you.

It’s been more than a week since I’ve returned from theInternational Academy of Eating Disorders annual conference (though returned is really a silly word as it was only 12 miles from my house this year), and I’m finally able to sit down and gather my thoughts about it. If you’ve never been, even if you’re not a clinician, I highly recommend. There is a lot of advocacy and research there and many things to learn. Next year it’s going to be in Prague! I certainly won’t be able to go, but I was psyched to have an opportunity to go this year as it was in San Francisco. With two littles at home, big travel is hard.

There were a few main themes ICED 2016 (International Conference of Eating Disorders) that were floating around:

Eating disorder research and treatment vs. obesity research and treatment. Wow. There was serious, serious controversy there. This is because obesity researchers as well as state funded grants (think NIH) are still using ideas such as food restriction, caloric restriction and BMI to measure recovery. All eating disorder clinicians and researchers have evidence that all of this, dietary restriction, BMI, “weight management” and dieting all lead to disordered eating patterns. Obesity researchers believe that obesity has to be treated because it leads to heart disease, Type II diabetes, etc. But Eating Disorder researchers and clinicians (and me too!) believe that when you focus on the obesity as the health problem, you are doing a disservice to the patient – you should be focusing on health and treating the specific disease. “Treating Obesity” continually leads to failure. Obesity isn’t a disease, but heart disease is.

Next off we discussed ADVOCACY a whole lot. People often think of eating disorders as a white woman’s disease, but the truth is that EDs hit not just white women, but women AND MEN across all races. In fact, Latina women have a higher incidence of eating disorders than white women. But most people of color or folks who aren’t cisgender tend to shy away from treatment – for many reasons. It’s not accessible (affordable), it’s not relatable- treatment is geared toward one gender and one race, and it’s stigmatized and unsupported by family and community. For instance, many years ago I had a client who, despite the fact that she had a horrific case of bulimia, her family would not support her treatment because they said it was a “white women’s disease.” She did come in for treatment and got great support from our treatment center and the treatment community but not from her family or her own community. This is not an uncommon situation. The fact that she came in for treatment is really fantastic, but most people don’t. The conference spoke a lot about getting it out there that EDs strike everyone everywhere and nobody should be ashamed to try and get help. And, as a community of ED professionals- we have to provide more help in different and more accessible ways. So lots to do there. And a note, if you are a human being who is not a white woman and you are suffering from an ED- please do reach out (you can even reply to this post) and I’ll point you in the right direction for treatment- thanks to this conference I have some really great resources now.

I met some of my heros of Eating Disorders, like Deb Burgard– and I was really seriously starstruck and took a selfie with her- it was more exciting to me than meeting say Johnny Depp (but honestly that would excite me too). If you don’t know about Deb, please click her name above and check out her work. She is a brilliant Psychologist, speaker and advocate for size diversity and Health at Every Size. I also got to meet Lizabeth Wesely-Casella fromBingebehavior.com – (have you read that blog? It’s awesome). And that was really exciting as well. Such amazing people do this work – it’s good work, and it’s hard work.

Body Positivity – A lot of people ask me why as a a clinician treating Eating Disorders I advocate for Health at Every Size and why it’s important. The answer is easy- almost every eating disorder started with a diet. If we can eradicate people being told that they are not good enough and they need to diet, we can deeply change the internalized messages that dieting is the only way out – we then allow people to live in bodies that were meant for them. Those bodies might be big or they might be small- but what we want them to focus on is their true health. True health isn’t about getting on a scale to measure your health. It’s about giving your body what it needs- good healthy food and good healthy movement (where you can), but of course movement and exercise can be difficult for those in larger bodies because of the social stigma. So it’s all very challenging and there needs to be a lot more kindness and acceptance out there. And the obesity paradox actually says that people in the “overweight” BMI category live longer and are healthier. So there you go. There’s no good science around these debates yet.

Body Image – The body image part was interesting. I talked to a lot of different experts on it. The consensus is really that body image is deeply ingrained and that we should be working on prevention more than anything else. The body projectis a good example of that kind of early intervention.

I went to a ton of neuropsych panels that were fascinating, but I’ll metabolize them into a different and accessible post soon enough.

Eating disorders are notoriously difficult to both treat and understand, but people are working really hard to make it happen and to find help for those suffering. Fortunately many people have gotten to the other side of their EDs and recovery is possible. If you need help, please reach out, you can reply to this post, email me directly or go directly to NEDA or call 800-931-2237.

When someone over the Internet promises you that they can help you lose weight, click away. Click FAR, FAR AWAY!

There is not one person who can guarantee you weight loss. Do you know why? Because they don’t know you and they’ve never seen you and they have no idea what is going on with your body.

Here’s the thing- I’m putting this blog post right out there to the billions of people in the world who might happen to read it. But what if I were to guarantee that I could help you lose weight? Or what if I told you the opposite, that there was no possible way you’d ever be able to lose weight? What if I told you I had all the answers? If I told you any of these things, I’d be wrong.

But then, why would I do that? Why would I possibly tell you that I had all the answers to your weight loss woes? What would make me think that I could promise or even guarantee you weight loss?

Well, perhaps I’d lost weight and I thought I could help you too, or maybe I’d read a lot about weight loss and I thought I was an expert -except for the fact there are no actual experts on weight loss, if there were, well then we wouldn’t all be out there spending millions looking to lose weight, it’s all very mysterious. The real truth is, I don’t know what you weigh, I don’t know what you’ve tried but most of all I don’t know what your body wants to be like.So I can’t promise you weight loss (I mean, not that I’d even want to, I think you’re perfect Love!)

Let me give you some concrete examples here:

Example 1: Kristi & Alison

Kristi is a client of mine who desperately wants to lose weight but also can’t seem to stop obsessing about food. She eats an egg and an apple for breakfast, a small green salad with some chicken for lunch and broiled salmon fillet with green beans for dinner and maybe a small glass of red wine. She can’t seem to get her weight under 145 pounds. She’s 5’2″ and according to the (very flawed) BMI – she’s considered “overweight.” Every day for years- Kristi has been eating basically the same thing. She’s petrified of cheese, she won’t touch bread and she spends at least an hour a day at the gym. She really wants to lose 20 pounds. She’s met with multiple trainers and weight loss gurus who explain to her what she’s doing wrong, “you need less carbs! you need more kettle bells!” Sometimes eats just steak and water for like 2 weeks straight. She loses maybe 1/2 pound but pretty much stays right around the same weight, she blames herself. She feels guilty, she feels ashamed, she feels like she’s doing something wrong. Kristi’s best friend Alison eats a bowl of honey nut cheerios every morning for breakfast. Later she’ll have a latte and a cookie, lunch is usually a burrito or some Pad Thai or whatever is easy takeout around her office and dinner is pizza or pasta or nachos or whatever. Allison exercises once in a blue moon, but it’s really not her jam. Allison also weighs 145 pounds, but she’s 5’7.” Which puts her BMI in the “normal” range. Kristi wonders why she has to work her ass off to be “slightly chubby” (her words not mine) while Allison does virtually nothing to stay at a weight that feels comfortable to her.

What happened here? Let’s dissect this. Kristi’s body type was and always has been more curvy. The truth of the matter is that Kristi could probably eat the same way as Allison and her weight would not change dramatically. Kristi’s extremely healthy body wants to be 5’2″ and 145 pounds. I say extremely healthy because LOOK THERE, look at what her miraculous body did for her- her metabolism slowed waaaayyyyy down so that she would maintain the weight that is healthy for her. Now Alison’s body is also most likely at the weight that is healthy for her and so despite the fact that nary a green vegetable passes her lips (really get that girl some broccoli) she still maintains a weight that is “socially desirable.”

So this is the big problem – when someone promises you weight loss, there is just no guarantee that your body will comply. Your body might also need more calories than someone else’s body or more carbs so when you dramatically reduce these things– what happens? You binge- you don’t want to binge- you just. cant. not. Your body really needs more because you were meant to be who you are.

Example 2: Stacy & Lori

My friends Stacy and Lori are identical twins. Real identical, not that Olsen Twin fraternal twin business, these girls used to be ONE ZYGOTE. Anyway, Stacy does Tae Kwon Do three days a week, she’s a second degree black belt and she can do like 500 push ups in a minute. She bikes all over San Francisco and has two kids that she pushes up and down those hills in a double stroller. She’s vegan too, did I mention that? Her sister Lori is different. She’s not a vegan, and she lives in the suburbs, so the most strength training she gets is lifting her kiddos up into their SUV. There’s no bike, there’s no pushing strollers up hills for her- she shleps her kids around town in a Honda Pilot, they go to pizza parties (Lori eats pizza). So the verdict? What are Stacy and Lori’s bodies like?

They are exactly the same.

They share clothes. They go shopping together and one tries something on for the other and then turns around so she can see how her butt would look in it. Their bodies are EXACTLY the same, because they have the same DNA. And Stacy is always exercising and fills up on mung beans and raw foods. Lori is never exercising and eats a lot less restrictively. But they look the same.

Summer Inannen recently wrote a post on Refinery 29 about how Paleo basically stole her life.And that’s really the thing, Someone can tell you that they have all the answers to your woes, that they can help you lose weight, that they can help you be naturally thin, that their answer is the best answer, that the food they are telling you to eat will give you tons of health, vitality, energy, help you lose weight, feel amazing and look years younger. But really, the answer is in your DNA. I’m not saying that you shouldn’t eat well. You should try to eat well. You should eat lots of yummy, high density nutrient foods that your body wants and that feel good in your body. But only youknow what that is. So eat, see what feels good in your body. Give your body lots of love and respect.

Don’t let anyone else tell you that you’re not doing it right or that you’re not doing enough. Anyone who tells you that has no idea about what your body needs. It’s not that I think people have nefarious intentions or that they even believe that they’re lying to you- but case after case has proven that even the most famous, highest ranking, highest paid, smartest weight loss guru can’t force your body into submission and make it lose weight if it’s where it wants to be and it’s healthy. You know what I’m saying, right Oprah?

Your body knows what it wants to be and it will tell you what it wants and what it needs. Listen to it, focus on feeling good and feeling healthy rather than changing the way it looks. So go now, eat, be strong, be happy, be kind to you.

Last month, my husband, kids and I went to the beach to get our last days of summer in. When we got there, I realized that I packed my sons’ suits and my husband’s suits but failed to pack my own. I was super disappointed-to say the least, there’s nothing better than swimming in Tomales Bay on a hot day. But I made the best of it and rolled up my cutoffs and waded in the water with my two year old. At one point, I squatted down to show him a tide pool and the back of my shorts got a little wet- I thought to myself, “Oh well, I’m already wet, I might as well jump into the water.” I took a deep breath and paused. I didn’t jump into the water, but I noticed, “wow, there is my black and white thinking just popping up again.” I have recovered from multiple disordered eating issues- but my thinking instincts still remain. My brain is still organized in that way. I didn’t react to the compulsion- I didn’t jump into the bay just because my shorts were a little wet because rationally I knew that they’d be dry in a half hour or so, but that if I jumped into the water- despite the fact that it would be super fun and satisfying for a few moments- I’d be uncomfortable in wet denim, I’d have sand stuck to me, and I’d have a long car ride home in dirty wet clothes. But I was extremely interested in the fact that so many years deep into my recovery- my thinking patterns remain the same. I was still vulnerable to polarized thinking. This is what black and white thinking (polarized thinking) is. It’s all or nothing.

Overeating is a super common binge trigger– it’s part of the cognitive distortion known as polarized thinking.

For instance- I ate two cookies with my coffee for breakfast, I might as well spend the rest of the day eating cake and cookies- I can’t eat something like a salad for lunch because I already “ruined” the day. OrI ate all my ww points for the day but then I went over a few points- I might as well binge or I don’t eat white flour or sugar, but I had a small bite of my boyfriend’s croissant. The day is ruined- Now I have to spend the day, the week, the month bingeing… or I ate two mini halloween candies, I have to spend the rest of the night testing every single candy and goodie that’s here. Or however your polarized thinking manifests for you. Bingeing because you overate is like seeing that you have one flat tire, getting out of your car and slashing the other three. It is not rational or logical.

Polarized thinking it is a process where you feel like you don’t have any choices. Had I not been able to recognize my thought patterns in that moment, I would have felt like I had to jump in the water. That I had no other choice since my shorts were already wet. This is a thinking process organized around perfection. “I have to be perfect or I’m nothing-I’m ruined.” There is no middle ground or allowance to be a normal human being who gets their shorts wet, spills coffee on themselves, or eats a bagel for breakfast. You believe that your choices are not your own. You might even feel paralyzed a lot of the time because you believe that if you cannot do it perfectly- you are afraid of doing it at all.

Now here is the thing about polarized thinking- you don’t have to let it affect your behaviors. Just because your mind becomes organized in that way doesn’t mean you have to follow your impulses down the rabbit hole. Part of mindfulness practice is slowing yourself down enough to notice your thoughts and then have the ability to change your action or reaction to your thought. Remember that thoughts are just electronic impulses, and we have 50,000- 70,000 thoughts each day. You can notice those thoughts before you react to them. You can choose the thoughts that you’re going to react to. For instance the thought, “I went out with friends tonight and I overate tortilla chips at this restaurant, I am full,” can often precede the behavior of going home by yourself and bingeing on lots of other foods. You are angry at yourself because you feel that you ate too much- but rather than sit with the fullness until it passes (like letting my shorts dry for a half hour rather than jumping into the bay with all my clothes on) you might believe that you have no other choice than to binge. But you actually do have a choice. Let yourself slow down and notice your thinking without reacting to it. If you eat a roll at dinner even though you didn’t intend to, remind yourself that eating the rest of the basket of rolls or going home and bingeing would be a lot like jumping into the bay with all your clothes on. No human being is perfect- and when you hold yourself up to that standard, you can often feel very limited by your choices and your ability to enjoy being in the world.

To deal with polarized thinking:

1. Slow down and notice your thoughts

2. Notice how your instincts want to react to those thoughts

3. Think about whether or not there is a different choice- a choice that’s more like allowing your shorts to dry and feeling comfortable again.

4. Try to implement that choice.

5. Notice how you feel the next day.

When you have black and white thinking, you believe that you have no choice and you have to take the extreme path. Recovery doesn’t mean that you will never have black and white thinking again- but it means that you will notice it more for what it is- a thought and a suggestion rather than a hardline on what you have to do.

What do you think? How are some ways that you’ve dealt with your polarized thinking?

I have an extremely complicated history and relationship with both Food Addict Anonymous and Overeaters Anonymous, both as a clinician who treats eating disorders and as a past member. A lot of people ask me “Does Overeaters Anonymous work?” It’s definitely not black and white. It “works” for some but not for others- but you have to define what “works” means. I want to share with you some of my personal history with it.

My First Experience with OA

Back in the 1990’s, when we were flannel clad teenagers, my friend Melissa and I sat in a field discussing when we would be able to go off our diets. We’d been drinking Diet Coke since our Bat Mitzvahs and trying to lose weight for longer than that. “Will we ever get there?” we wondered. Our mothers, both in their early 40’s at the time were still dieting. Thin, but dieting. Always dieting. When will it be done? Doesn’t it seem like dieting should have some defined end? Like that you go on a diet for 6 months, lose your 10 pounds and then you’re not on a diet anymore? But no, we were always dieting, and our mothers- always dieting, and our mothers friends- always dieting and our Aunts and cousins and friends’ mothers – always dieting. It didn’t end. And so when Melissa ended up dieting herself into a nasty bingeing and purging habit that lasted years, her therapist insisted that she join Overeaters Anonymous to cure her. “It worked.” I say it that way because it worked in the sense that she stopped bingeing and purging. She also finally lost the 10 pounds. Plus more. In fact, at 5’7″ she wound up weighing less than 100 pounds, losing her period and growing a nice coat of *lanugo all over her arms and legs.

I asked her if she was eating and she said, “Oh my god, I eat a ton! Lots of fat and oil and vegetables, and meat. It’s great.”

And then one day, after exactly 478 days of “abstinence” she binged.

And it wasn’t just a binge- it was a binge that brought down the skies and the heavens and the thunders- one of biblical proportions where hours ran into days ran into weeks ran into months. She stopped answering her phone, she stopped leaving her house except at night to go to the 24 hour grocery store to buy binge foods, she stopped going to work and to school… It was a binge that cost thousands of dollars, that clogged her toilet with vomit and it was a binge that hit her with a force that felt unbeatable. She was crushing under the weight of it. She couldn’t stop bingeing, she couldn’t stop purging, she couldn’t stop running to the store to buy more binge foods. She put on 70 pounds in 6 weeks. “Fuck,” she told me, *”I need help.”

That’s where her relationship with OA ended. Her friends and sponsor dropped her, she couldn’t get back to where she was and she hated herself. She wound up back in treatment but this time without OA.

My next was sometime right after college. Although I was no longer dieting, no longer restricting, no longer controlling my food, I still felt trapped in thinking too much about weight, body image and calories. It was making me crazy and I wanted it to stop. I longed to feel peaceful around food and embrace my body. A friend of mine who I respected enormously told me that she had found deep recovery in FA, that she no longer had any desire to count calories, hadn’t binged or purged in over a decade and really felt comfortable in her body. She said she just didn’t worry about anything food related. I wanted what she had. So, together, we went to her home meeting where she introduced me to my new sponsor, Kate. When Kate first met me, she looked me up and down, sneered and said, “you’re not fat, why are you here?” I explained to her that I wanted peace around food and my body image. I didn’t want to worry about calories and I was sick of unintentionally doing math in my head all day long- that it was stressful and I just wanted to be free. She gave me a food plan and she assured me that it would cure me but said that I had to buy an electronic food scale, an electronic human scale, weigh and measure every morsel that I ate and call her at 6am each morning and report my weight and my food into her. I explained to her that I didn’t want to be on a food plan and I didn’t like to weigh myself. She told me that this was the way that I could have the recovery that I wanted without being willful or being stuck in my disease. She said that the food plan was the way out- but that I had to follow it perfectly otherwise it wouldn’t work. She told me that there was a line of people waiting to be her sponsee so if I didn’t want help and I didn’t want to recover and if I wanted to spend the rest of my life a compulsive overeater that it was fine, that I should leave. I felt ashamed and embarrassed. Rather than finding a different sponsor (now I know) I decided to work with Kate, because after all, it was the only way and she had lines of people behind me begging her to be their sponsor. She must be right.

The first day on my meal plan, I was so hungry that I ate an extra apple between breakfast and lunch. Kate scolded me and told me that it showed a defect of character. If I was hungry I needed to drink black coffee, black tea, diet coke or chew sugar free gum. Each night I went to bed feeling starved, with my hands on my belly feeling my ribs for inspiration and saying “I don’t eat no matter what- I don’t eat no matter what…” as I tried desperately to go to sleep. My eating disorder hands and eyes were reactivated as I felt the outlines of my bones and stepped on the scale every morning. The obsession was familiar and it was easy. It was easy to get pulled back into that vortex. Only this time, my Eating Disorder wasn’t inside my head- it was Kate. I’d allowed her to be the voice of Ed- dictating my behaviors for me and shaming me if I went off program by taking a bite of a carrot while I was prepping my lunch – and sending me back to day 1. I felt like Sisyphus.

I drank gallons of diet coke each day and chewed packs of sugar free gum. My stomach swelled up from the aspartame and carbonation- I wasn’t able to run or swim or exercise at all- I found myself breathless, my thought process was often slowed down and to be frank, I hated my sponsor. It was this one day that I was sitting there and more than anything I wanted to put some milk into my tea. My stomach was so bloated and I was so hungry. I called my sponsor to tell her how stressed out I was- how I wanted to go for a run but I had no energy, that I wanted to hang out with my friends but they were going out to a cafe and I couldn’t sit around all that latte’s without wanting one, that I was depressed, that I hated the way I felt. She told me that I should be grateful for being abstinent, that I shouldn’t think about running or socializing or exercise, that it was the time to figure out my food shit, to go to a meeting, that my complaining was showing a defect of character. I just wanted to put some goddamned milk in my tea. And that’s when I realized it, this group was insane and it was driving me crazy as well. I knew that putting milk in my tea wasn’t worse than drinking liters and liters of diet coke a day. Yet in this sect of FA- putting milk in my tea meant I had a character defect, but drinking liters of diet coke every day was okay- chewing gobs of gum was okay. Honestly – there wasn’t much payoff for me- Besides an initial couple of pounds, I wasn’t losing much weight at all- which in retrospect, I understand was a good thing- my body was at a healthy weight and my metabolism had slowed way down to compensate for the restriction of calories- the numbers in my mind had only gotten worse. I called Kate and told her that was leaving the program that moment.

Being an FA drop out was a no-brainer for me. But it’s not like that for everybody.

I have seen people go in and lose 100’s of pounds for the first time in their lives- and then feel like they owed that organization their life. But when they decided to go off plan or put weight back on (which lots of folks do) all the people who supported them, the most important people in their lives turned their back on them, shamed them. Made them feel like they were bad people. Because they ate cake or because they wanted something different. I’ve seen women who haven’t had periods for years- and have that be supported by the group, with many women telling them, “yeah, that’s normal, nobody here gets their period…” In some cases of OA- eating disorders are supported and it just becomes a huge support for ED under the cloak of recovery.

And that’s part of what makes OA and FA so confusing.

My next experience with OA was when I was a graduate student in Psychology learning how to treat Eating Disorders. I interned at an Intensive Outpatient Treatment Center for women with Eating Disorders. The protocol was that every client needed to go to 3 OA meetings a week- no arguments – or they were out of treatment. It was rough. Although many clients were getting amazing recovery, finding lots of support and fellowship in the rooms, some were feeling traumatized, pained and so wounded by the program, but they couldn’t leave otherwise they’d be kicked out of treatment and then where would they go? It was definitely extremely difficult to watch and be a part of. I knew how wounding OA could be and I saw that their choices were being taken away from them. Sometimes in recovery, taking away choices is liberating- that way the patient has nothing to focus on except themselves, but other times it is extremely harmful. No two people or recovery stories looks the same so you have to find what works for you – for your mind, body and spirit wholly.

My own personal experience with FA had really skewed my feelings about the fellowship. The problem is that FA and often Overeaters Anonymous tells people how to eat and teaches them not to trust their instincts. And that’s really the concept that they are coming from, “you are a compulsive eater and so you can’t trust your instincts because your instincts will always be to overeat.” This is a cognitive distortion known as emotional reasoning. You believe something to be true and so it is.

“Whether you think you can, or you think you can’t–you’re right.” ― Henry Ford

You believe that you cannot stop after one bite of chocolate – or that if you eat flour or sugar- it will lead you to binge eat and you’ll never be able to stop, so the best thing to do is not eat it at all. This belief triggers black and white thinking for most.

In OA- where people count days of “abstinence” from their drug of choice (food), they have to start their day count all over again if they eat even a cracker or a slice of white bread. So, let’s say you were in OA and you had 100 days off of sugar and flour. Then one day you had a small bite of birthday cake. You would have to start on day one the next day- so you ruined your abstinence already- why wouldn’t you go to the store and buy a gallon of ice cream and cake- you’ve ruined your abstinence and have to start on day one tomorrow anyway. OA is a huge setup for binge eating. They will tell you that you cannot eat birthday cake because it will trigger a binge for you. You then believe that one bite of sugar will trigger a binge for you and so it does. And it should because your belief is that your day count is ruined and after today you won’t be able to have any cake again, so you might as well binge on all the cake you can. See what I’m getting at? Certain sects of OA keeps people in huge diet mentality and shames them (it’s a defect of character) if they eat off program. It’s a self-fulfilling prophecy. You think that one bite of white bread or a bite of birthday cake will lead to a gigantic binge and so it does- and all the parameters for that to happen are set up in the OA infrastructure. And then, a binge eating habit or disorder gets activated.

I’ve had hundreds of clients over the years come in both damaged and traumatized by groups like OA, Greysheets, HOW, and Food Addicts Anonymous. They are in a place where they can’t stop bingeing and they are feeling shamed and angry at themselves. They just want to get their abstinence back- but they can’t. They can do 10 days or 2 weeks – but they seem to just not be able to get to that multi-year abstinence that “everyone else” has. Oh yeah, that’s the other thing- they somehow believe that they are alone in their struggles with OA. They believe that they are the only ones and that they are bad. The feel ashamed. OA then becomes their own inner critic and often takes the place of their own over-critical parent. It’s retraumatizing. They’ve given their own inner critic an office and a team. And the worst part is feeling totally alone, without your tribe, your village. If you are someone who feels this way, you are not alone. I see multiple OA/FA drop outs each year who have scars and trauma from the fellowship, who have been rejected by this “family” because they cannot get their abstinence back. You are not alone. If you are not comfortable with the group and you have an instinct that something is wrong, their probably is.

But is there any good to OA?

YES! Definitely. OA is a fellowship where you can find other folks struggling with the same issues that you are. One of the best things that you can do for recovery is get support and OA definitely has support. There are some amazing OA groups out there- where you will find smart, kind people who want to help you recover spiritually and not make it all about the food. There are some people who have life long amazing recovery in the rooms. Though I’ve seen people find pain in OA, I’ve also seen people find amazing recovery. There are some really amazing fellowships out there that don’t rely on food plans, or rigid rules. You have to find what works for you. As they say, take what you need and leave the rest.

If you want to find some recovery in OA here are my suggestions- this is what I’ve seen that really helps people recover in OA.

1. Don’t define your abstinence as abstinence from a food. Define it as abstinence from a process. For example: Abstinent from obsessing about food and calories. Abstinent from dieting. Abstinent from bingeing. But never abstinent from flour or sugar or anything like that. That puts you right back into diet mode.

2. Find a sponsor who will work on you with your steps – but not with a food plan- don’t call your food into anyone. If you need a food plan for recovery- please see a registered dietician who specializes in treating eating disorders. Find one here or here.

3. Find like minded people who report a recovery of self love, kindness and a mind body and spirit connection. Try to stay away from the weight loss and dieting parts of OA.

4. Go to several different meetings until you find one that really resonates with you.

5. Consider eating disorders anonymous as well. Their principals are more aligned with eating disorders as a process and dieting as part of that process.

6. Understand that everyone is doing the best that they can– have compassion for everyone around you and honor their process. Don’t judge people’s choices in OA nor their relapses, it’s always important to have oodles and oodles of compassion for yourself and for those around you. Honoring your own process might mean that your needs change at different times.

The situation is not black and white. There are many people who have found complete peace with food and their body image in OA- however there are as many who have not. If it feels right and good and your are happy- stay. But if it feels bad – listen to your instincts. You have everything you need inside of you to know what you need.

I want to tell my husband about my eating disorder but I’m so stressed out because I really don’t know how to tell my husband about my eating disorder. I know things have to change. I don’t know how to have this conversation, how to start it or where to get help. I’ve had this since I was 17 and i’m 29 now I really don’t want to go on like this.

Answer: I’m so sorry that you’re dealing with this, but I want to commend you on putting it out there and dedicating yourself to recovery. It’s extremely difficult to tell your husband about your eating disorder for so many reasons.

You might feel embarrassed and ashamed and not want him to see you in a new light

You might feel that if you tell him about your eating disorder that he might try to stop you

Your eating disorder is so private and such a precious thing (even though we hate having them) disclosure would be exposing and difficult.

You might be afraid of his reaction since you don’t know how he’s going to react.

Here are some ideas on how to tell your husband about your eating disorder.

Consider the worst case scenario. How will he react? What is the worst thing he will do? Will he leave you? Will he divorce you? In most situations, probably not, but really sit and think about what the worst thing can be.

After thinking about this, consider bringing your husband with you into your therapist (if you have one) or if not, check out ED referraland see if you can find an eating disorder therapist to bring your partner to. It might be easier if you have a professional there. If you are not interesting in discussing it with a therapist, no problem at all. You can do this alone.

Set aside a day and time to tell him. Make sure that it’s not over a meal and make sure that it’s not at night. Your husband will likely have many questions and will spend a long time asking you.

Make sure that he knows that it’s not his fault and make sure that he knows that you are looking for help.

Make sure that he knows that you don’t expect him to be the one to cure you.

Sit down with him or take a walk with him and gently explain that you’ve been dealing with this for a long time and you’re ready to reach out for support. You can say something like, “When I was 17 years old I started to make myself vomit after I ate. This habit sort of spun out of control. I have spent the past 12 years dealing with this horrible secret and trying to stop on my own. I haven’t told you because I’m so embarrassed and so ashamed, but I don’t want to have secrets from you, and I don’t want to live like this anymore. I want treatment and I want to stop. And all I need from you is love and support. I know that I can beat this now that it’s out in the open and I’m asking for help.”

Tell him that your eating issues have nothing to do with him.

Tell him that you don’t need him to “fix” you.

Tell him not to tell you what to eat or what not to eat, that’s your responsibility, and it’s not good for your relationship.

Tell him what he can do to support you. Maybe that’s talking about feelings more often or helping you find a therapist or treatment program or driving you to treatment.

Ask him not to talk about diets, calories, burning calories, losing weight, or what your body looks like.

If there are some foods that you don’t want him to have in the house, ask him to support you in that way

Request that if he catches you in a binge, it’s not his responsibility to make you stop doing it, nor should he take food away from you, nor should he shame you. Instead, maybe he can say something like, “hey, is everything okay? do you want to talk? I’m here for you.”

Ask him not to be your food police.

Give him space to talk about his feelings and what it’s like for him to learn this about you.

Give him the opportunity to ask you questions. If you feel uncomfortable with certain questions, let him know that you’re not ready to answer them yet or that you don’t know the answer right now, but as you work through recovery, you will let him know what emerges for you.

When I was home from college one weekend, I walked into the kitchen and lifted the cover off the pan to see what my Mom was cooking us for dinner. Squash, onions, brown rice, tofu… the usual. I picked up the wooden spoon and began to mix the stir-fry. “Stop,” my mother told me as she gently placed her hand over my wrist, “you don’t want to make the vegetables dizzy.”

My Mom had lots of new-agey philosophies and was always reading a book or participating in certain spiritual food fads, some which were downright obsessive or unhealthy like the *master cleanser (lemonade diet that we’ve all come to hate), or *Fletcherism(which means chewing your food 100 times before you swallow it- even your water), or a *liver detox (where you swallow nothing but apple juice and laxatives for a few days) and some that more mainstream and had deeper philosophies like Veganismand eating a seasonal Macrobiotic Diet. Many of them were just oblique ways of masking disordered eating into a spiritual path- but there were a few things within the many different things that she tried over the years that were valid and made sense.

That moment with Mom pops into my head a lot, where she lovingly put her hand on my wrist and warned me against making the vegetables dizzy. I remember smiling at her in an amused but adoring way. She wanted to keep the energy of the food balanced and stable so that when she fed it to me, the food would help me to remain balanced and stable. Her philosophy at this point in her life had a lot to do with the energy that you put into food and how that energy reflected back on you. She was ill and wanted to regain health and she felt that this was a path toward that.

She had integrated this Eastern Philosophy of being aware of the Qi (life force) in everything- including her food. She believed that what you put into the world around you, that you would get out of it. So she chose love and kindness toward her food and hoped and believed that it would return to her and to me.

I’ve often felt in the years since I’ve lost my Mom that this might have been a healthy path that she came to too late. I don’t necessarily think that it would have saved her life, but I wonder if it would have saved her lots of fruitless years on senseless diets and food and weight loss fads.

I want to put out an experiment to you. What if you took a day and showed loving kindness to everything you ate? If you can’t do a whole day, what about one meal? You don’t have to eat just brown rice and kale or green smoothies (making smoothies makes the vegetables dizzy anyway… 🙂 But what if you were to take even a piece of pizza or a cookie and look at it before you ate it and said something like, “You are loved! Thank you for providing me with your nutrients, your yummy taste and the enjoyment I will get from eating you…” what do you think that would do? Do you think it would help you slow down? Do you think that it would alleviate some of the guilt that you might sometimes feel around eating certain foods? Do you think that it would help you to be more mindful about the food that you were eating and the intention that you had around food? Try it, let me know how it goes.

Leora, I am having a hard time with a binge that comes from “just one candy, cookie, etc.” I will be craving something sweet and then say I’ll have one piece of chocolate and then keep going back for more. I don’t know how to avoid that cycle and do something else instead of binging. Sometimes after the one sweet thing I want something salty, too, and then I’ll end up binging by going back and forth between the two foods. Can you help me?- Jodi

Hi Jodi, I know this problem well! This is what I call chasing the taste. You end a meal only to need the opposite taste in your mouth. Salty becomes sweet, sweet becomes crunchy and salty, crunchy and salty becomes fatty and warm… there is something that you want but… you can’t quite find it, and you spend the better part of an hour chasing after a sensation in your mouth to satisfy that desire. Before you know it, you’ve ended up bingeing. I have some tips for this. Try them and let me know how it goes.

Before you begin eating the desired food that can potentially start a binge, create an intention around it. Tell yourself, “I’m going to eat this piece of chocolate and I’m going to enjoy it and it’s okay for me to do that,” and then put it on a plate. I would also choose to eat more than one piece, because one small piece of chocolate is not necessarily satisfying. Put a couple of pieces on your plate and put the bag away, close it tight and put it up on a high shelf, one that you have to climb to get to or in the freezer under something else.

Remind yourself that there have been times when eating one piece of chocolate has led you to chasing the taste and looking for something else, but that you are choosing a different behavior now.

Sit down with your chocolate slowly. Taste it in your mouth. Feel the sensation of the chocolate melting on your tongue. Notice what it feels like and notice what you feel like when you are eating it. When you are finished, note any sensations that you are having to run back to the kitchen and get more or something else. Ask yourself if you are chasing the taste. If you are, either drink a glass of water, or walk into the bathroom and brush your teeth, or rinse with some mouth wash… anything to change the taste in your mouth and help you to interrupt the compulsion of chasing the taste and using food to elicit different taste sensations or sensory experiences for yourself. After you’ve changed the sensations in your mouth and tongue, sit for a moment and do some breathing- breathe into your nose to the count of ten, hold it and exhale to the count of ten. Do this 6 times to give yourself 2 minutes of breathing. This will calm your amygdala, bring more oxygen to your brain, help you to regain your senses rather than letting the food cravings hijack your brain and suck you into a binge. You now have more authority and a choice about what you want to do. The fact that you’ve put the food in a hard to reach place will also help to interrupt the compulsion to keep eating.

I hope that helps you J!

Take good care of you and I’ll talk to you soon. Warmly,

Leora

Do you have a question about binge eating, bulimia, anorexia, or anything associated with eating? Send an email to bingeeatingtherapy at gmail dot com. All questions will be kept confidential. Include your first name or the name you want to be referred to as and your location. Are you interested in online therapy or coaching to deal with your eating disorder? Please contact me to discuss getting started.

Last week, one of my clients said to me, “Leora, can you just teach me how to gain self-esteem? If I just had some self esteem my life would be so different…” I knew what she meant. She tries to use her eating disorder to give her self confidence. She believes that if she were thin enough that she would be worthwhile and important, but if she is not thin enough, she is a worthless human being with no value. But she is never thin enough. And so her life has been spent waiting to feel valuable and trying to be good enough. Her focus is always on her weight and never on anything else. Her critic is always telling her that she will be better, more people will like her and she will be happier when she is thinner. She is already very, very thin.

What she thought was that she could “get self esteem,” like gain something that she’s never had before, something new. The truth is, having self esteem isn’t about harnessing some mystical force or acquiring something new- it’s about letting go of something old– old messages that tell you that you’re not okay, that you have to be better than you are, that there is something wrong with you. Self esteem is about being kind to yourself, accepting and loving yourself even if you’re not perfect. Self acceptance can often become confused with settling for something that you don’t like. But that’s not what self esteem is about. It’s about accepting who you are in the moment and accepting that it’s okay to be who you are as you go toward greatness (even more greatness!) and allowing yourself to evolve, but caring for yourself and being kind to yourself and even loving yourself in that process. It’s about holding yourself with integrity to the best of your ability, always being kind, thoughtful, compassionate and loving to the people around you and to yourself. It’s about knowing what your values are and doing your best to uphold those values. So, when you hear the voices telling you that you’re not okay and that you won’t be okay until you… CLIMB MT. EVEREST, RUN A MARATHON, LOSE WEIGHT, FIT INTO A SIZE XX JEANS, READ WAR & PEACE, WRITE YOUR FIRST NOVEL, BECOME A BEST SELLING AUTHOR, MAKE 6 FIGURES, GET MARRIED, HAVE A BABY, QUIT DRINKING, QUIT SMOKING, QUIT EATING CARBS, EAT NOTHING BUT KALE SMOOTHIES AND SUNFLOWER SEEDS, BECOME A VEGAN, HAVE CLEAR SKIN, GET YOUR MBA… Or whatever those voices are telling you, remember that you don’t have to engage with those thoughts. It’s not true and it’s not real. It’s okay to be okay with who you are in the moment instead of after you’ve done these things. People confuse acceptance with resignation and defeat. Acceptance doesn’t mean resigning yourself to being stuck in your circumstances. It means accepting that you are in the place that you’re in now and you don’t have to wait to be who your are until after you’ve changed your circumstances. It means that you can be yourself now and thrive and be in the world while at the same time improving your circumstances. We all have goals to achieve, that’s part of what makes us psychologically healthy and what helps us move forward in life. But when you get into the cycle of “I won’t be okay until…” you set yourself to be unhappy and you have a very hard time finding happiness… because it’s never enough.

So, how do you do this? I’ve created 10 tangible steps to achieving self-esteem. You don’t have to do all of them right now. But just try one this week and see how it goes. When you start to feel a difference, try another one. I know that doing these exercises will be life-changing for you.

1. Make a List of What your Values Are

Think about what is fundamentally important to you and write it down. This could be being a kind and compassionate person, being the kind of person people turn to when they are having troubles, not judging or criticizing other people, living with integrity, having positive intentions. Knowing that you are never going to be 100% at all these things, when you are feeling badly about yourself, check in and ask yourself if you are doing your best to live in accordance with your values. If you are, then you can fall back on that foundation of strong values and strength. If you are not, give yourself a reminder of what your values are and try to live according to them. So, if someone does or says something to you that hurts your feelings or if you yourself say or do something to yourself that hurts your feelings, check in with yourself and ask, “am I living according to my values? Am I behaving and acting in a way that I can feel good about? Am I acting like the kind of person that I would want to have as a friend?” And remember, we always forget to do these things and fail at them sometimes, and that’s normal, but having your values written down in a list form can be a great reference for you to come back to. It will help you remember what is truly important to you and when you remember and when you live according to those values, you find self-efficacy.

2. Don’t Compare Yourself To Other People

Your values and your dharma (path) are different than anyone else’s, so you just can’t compare. You can’t compare your money situation to anyone else’s, your relationships, your jean size… we were all born with our own individual paths. When you begin to look at other people’s paths and think that you should be like them or different from who you are, you fail to move along your own, or you reject your path. This inherently makes you feel bad. This keeps you from moving forward. You also shouldn’t be comparing your backend to anyone else’s front end. Meaning, you can’t compare the knowledge that you have about your own situation to what someone else is outwardly showing you about their own. You never know what is going on with someone else. As M. Scott Peck says in The Road Less Traveled, life is hard for everyone, not just you. And once you remember that life is hard across the board, you can transcend the existential angst and pain that comes with the difficulties of life. You can understand that when things happen (you get a parking ticket, break your arm, get into a car accident, lose a parent) that it’s painful and it’s difficult- but you are not alone, that bad and difficult things happen to everyone who chooses a life of being human.

3. Do Things for other People Often

Performing acts of kindness actually makes you happier and boosts your self esteem, making you feel more valuable and more at peace. A study published in theJournal of Social Psychologyshowed that participants who performed directed acts of kindness every day for 10 days in a row showed an increased level of life satisfaction. Self-esteem comes from life satisfaction and feeling your value in the world. Doing things for other people can be as small as smiling at someone when you are walking down the street or as big as volunteering your time to help someone out. It can also be remembering to give loved ones around you big hugs, kisses and compliments and reminding them why you love them so much and telling them how proud you are of them.

4. Live Mindfully – Mindful living is about being aware of your body, being aware of your choices, your environment, being mindful or your choices, your environment, your bodily sensations, your thoughts, your actions and your fears. Often, people who are suffering with eating disorders have a really rough time living mindfully. They reject their true needs to focus on the goal of weight loss or looking better and either binge or starve themselves, they don’t honor their appetites, they hate their bodies because they believe that there is something wrong with them. They completely reject themselves. When you are living mindfully, you are working to honor the needs of your body.

5. Learn Self Acceptance: Part of self acceptance is knowing what your strengths are and honing in on those and not punishing yourself for things that you are still working on. Make a list of things that you are good at and that you like about yourself. Be with that list and do more of those things. Make another list of things that you are not so happy with and that you want to change. Tell yourself that it is okay that you are where you are. And that it doesn’t make you bad and you can still like yourself and care for yourself as you are working to change those things. Get love and support and help for changing the things that you want to change. Change and healing is difficult all alone and in a void. But when you find other people who are working on the same change together, you have a group of encouraging, loving folks to keep you accountable and to be kind to you when you fall down. You can also do the same for others which will help you (see #3!)

6. Take Responsibility for Yourself: This is about not blaming other people for choices you made. Understanding that you have power and that you are not stuck and that just because you made a bad choice, you are not stuck in it because you have the power to constantly be rethinking and recreating your life. If you make a mistake, don’t shift the blame. Don’t say that you did this thing or said this thing because someone made you. For example, “I’m sorry I yelled at you, but if you weren’t acting so irrational, I wouldn’t have.” You have just negated your apology and given away your power. Always take ownership for your actions. Knowing that you have it in you to make your own decisions based on your own values (see #1) is part of what gives you self efficacy and self-esteem. Saying that someone else made you yell or act mean or say something wrong basically says that you have no power to make your own decisions about how you behave. Remember that you almost always have the power to undo a decision that you made.

7. Be an Advocate for Yourself: When you have self-advocacy, you always treat other people with respect and you do not allow other people to talk down to you or to treat you poorly. If you have a boss, for instance who is verbally abusing you or yelling at you, it’s okay to look at them and say, “it’s not okay to talk to me that way.” You also stand up for others who might not have the ability to voice their own needs. If you are unable to stand up for your own needs and have your own voice, you find someone who can be an advocate for you.

8. Live with Purpose:

Consider yourlife’s purpose.When you begin to live with purpose, you take care of yourself, but your main purpose in life isn’t about getting thin or getting pretty or making money or trying to impress or look good to other people. It’s about having goals that long term feel important and meaningful to you and using your life to work on these goals that help the world at large.

9. Have Lots of Integrity:

What is it to live with integrity? In my opinion, it’s to be as honest as you can without being hurtful. Being honest doesn’t mean telling someone that they look fat in their new dress or that they’re acting like a jerk. That’s not honest, that’s your subjective opinion. Being honest is more like telling someone that your feelings were hurt when they didn’t answer your phone calls or respond to your messages. Being honest is not stealing, not lying, not purposely saying things to hurt people, not spreading hurtful rumors, and not using other people to achieve your own means. It’s about being kind, being helpful, but also not sacrificing yourself or your own needs for the sake of others. Personal integrity is about knowing what your values are trying to live up to them. (See #1). When you identify your values and do your best to live up to them, you will always know that you are okay and you won’t have to worry about what other people think about you.

10. Challenge Your Inner Critic-

What would it be like to gently let go of the old thought patterns that you are so intensely holding onto? As I said earlier, self-esteem isn’t about gaining or building and changing, it’s about letting go. Imagine the beliefs that you have that plague you and make you feel bad, (ie: “I have to be thinner, I have to be smarter, I have to be cleaner, I have to be richer, I have to be prettier…) and just choosing to disengage with them. Choosing instead to engage with the above ideas that are helpful and help you to feel better about yourself than the thoughts that intrude into your mind and keep you from living your life with zest and enjoyment. That doesn’t mean you won’t have these thoughts pop up. They are old and part of old patterns. However, what about trying to hear them like background noise (like a fire engine siren outside) but not follow them. Let them fly through your mind, notice them and rather than grasping onto them, think about doing things that align with what makes you feel good about yourself.

When we were in our very early 20’s, my friend Catherine and I were working together as tech journalists in Silicon Valley. It was the first tech boom, we were recently out of college and people around us had lots and lots of money. People who were 24 years old were worth many millions of dollars, but we, two grammar geeks who worked as reporters for an online dot com journal were worth much, much less. At least on paper.

One day, while we were working together on an article about the Diamond Rio Mp3 player (you could listen to 14 songs straight! No tape! No CD!) Catherine, who had been the valedictorian at both her high school and her college just broke down crying. As I said, we were in our early 20’s and breaking down crying at work at that age is socially acceptable as it’s always okay to have an existential crisis. I asked her why she was crying and she said, “I have no idea what I’m worth.”
“What does that mean?” I asked her.
“Well, I used to know exactly what I was worth. Somewhere between 4.2 and 4.4. But now, I’m not graded on life and I only make $2,000 a month. So what am I worth? How will I know? How will I know how I’m doing in life without grades?”
“I think,” I told her, “I think we’re supposed to know how we’re doing by how happy we are, I think we’re supposed to let our happiness be a barometer of how things are going.”
“That’s the stupidest thing I’ve ever heard in my life,” she said.

And I guess that’s the thing. I guess that we all start out being graded and we just keep going with it. We let numbers dictate how we feel. Whether it’s the number on the scale, the size of our jeans, the amount of calories or carbs we ate, the size of our paychecks, the number of men or women we’ve slept with, the square footage of our house, the cost of our car, the number of carats in our engagement rings, what kinds of grades our kids our getting, how fast our most recent marathon time is…

After healing from my food and body image issues, I had really felt that I stopped allowing numbers to dictate my life. But I realized that I hadn’t. A few weeks ago, I checked my amazon stats to see how my book was selling. For whatever reason, it happened to be a bad week for book sales. I was crushed. I started to tie up my self-worth to my book sales, thinking that not only did my book suck, but I sucked. I really let myself get down in the dumps about information totally unrelated to who I was as a person, how I lived my life and what my values were. Later that evening, I got a beautiful email from a reader telling me that my book had changed her life. And then I remembered. I remembered that I wasn’t about sales or numbers or stats, I was a person. And that I do what I do because I care about other people. But I’d forgotten and I’d tied up my self-worth to silly things like book sales and blog stats. Then I realized the irony of it. I tell people all the time that their self-worth is not tied to some arbitrary number on a machine based on nothing and yet, I allowed my own self-worth to be tied up in that. It was a huge reality check for me. So I asked myself a few questions.

1. What are your values?
2. Are you living up to your values?
3. What more could you be doing to be more of who you want to be?

I remembered that my values were about my husband, my children, my family and helping people, and that numbers had nothing to do with any of this. I remembered that I was living up to my values and that I didn’t need to be graded on this and I remembered that I wanted to do more of this. So I chose to stop looking at my book stats unless my kids were asleep and to make sure that my time with my kids was valuable and loving. That felt good and it felt right and it helped me to get out of the slump of numbers.

Your self worth is also not tied up in numbers.

Ask yourself these questions:

1. What are your values? Name the most important values in your life.

2. Where do you find your value?

3. What do you value in others? What makes others worthy and valuable in your mind.

4. Where do you find your worth?

5. What are things that you do or can do every day to help you feel your true and authentic value?

Write them down and answer them one by one, thoughtfully. Then, each day, ask yourself, “How am I being true to myself? How am I living in alignment with my value system? How am I being who I want to be? What can I do to be more in line with my authentic self? What is the one thing I can do today to help me really be me, the one thing that it is not number based….” Then do that thing, even if it is as simple as calling your Grandma, or hugging your kids or picking up a piece of litter in the street. When you define your intrinsic values and live according to them, you begin to really feel your self worth and you also let go of jealousy and trying to measure up. Try it!

Post navigation

You CAN Stop Binge Eating!

If you want to stop binge eating and find peace around food and your body, then YOU HAVE to read this book. It will give you step by step instructions and guidance on how to rewire your brain so that you can stop the cycle of binge eating.

Hypnosis and Guided Meditation Downloads

Hypnosis and meditation can be a wonderful complement to any recovery program. It is relaxing, peaceful, calming and effective in helping you reach your recovery goals. To download a hypnosis or guided meditation session and start relaxing right now, you can

And for additional hypnosis and guided meditation MP3s related to things other than food and body image issues CLICK HERE

Categories

Categories

Recover

This is a blog to promote the awareness of eating disorders and to receive some help and support for healing from binge eating and bulimia. A good place to start is here!

Send me any questions you might have about eating disorders, recovery, therapy, binge eating or compulsive eating, body image issues, bulimia, or anything else that falls into that category. I will do my best to answer on Q&A Fridays. Email all questions to:
bingeeatingtherapy (at) gmail (dot) com.
If you live in San Francisco and are looking for Psychotherapy for help with food and body image issues, please don't hesitate to contact me at: 415-820-1478
leorafulvio.com